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Health and Humility


 

Pamela Valenza, MD

Posted: March 14, 2024

 

 

Diabetes. That word can mean a lot of different things to different people. It can also be really scary or intimidating! Today, we will be talking about diabetes: what it is, what it is not, and the importance of maintaining regular health care. With the right information and tools, we’ll get more comfortable with and build confidence in understanding diabetes, how to prevent it, and how to ensure proper diagnosis and treatment.

 

Almost everyone reading this column likely knows someone who has diabetes. Diabetes is when the sugar levels in our blood get too high. This can happen because our body is not producing enough of a hormone (insulin) that helps turn the sugar that we eat, whether that is added sugar or carbohydrates that break down into sugar, into energy (glucose) to be used by our body, or because the body does not respond the same to the levels of insulin that our body produces. Over time, untreated diabetes can lead to complications in the eyes, kidneys, blood vessels, and nerves. When sugar levels in the blood are higher than normal, but not quite high enough to be diagnosed as diabetes, this is considered prediabetes. Prediabetes is a warning sign that you are at higher risk of progressing to diabetes if changes are not made to bring the sugar level down. Without regular appointments and physicals with your medical provider to check bloodwork or to discuss risk factors, it can be hard to work on changes to prevent diabetes and to diagnosis diabetes early. Risk factors include being overweight, eating high calorie foods regularly, a less physically active lifestyle, and genetic factors such as family history. If you have any of these risk factors, it is not guaranteed that you will get diabetes at some point in your lifetime, but you are certainly at higher risk. One way to prevent diabetes is to work on making small changes in your everyday life to decrease your risk (i.e. achieving a more healthy weight, eating a less high calorie diet, being more active). We’ll talk more about this in a little bit.

 

First, diabetes is very common. The American Diabetes Association estimates that in 2021, 38.4 million Americans (11.6% of the population) had diabetes and among the Latino community, 12 out of every 100 adults are diagnosed with diabetes. However, many people who have diabetes go undiagnosed, meaning one out of every 5 people who have diabetes live their life without knowing they have diabetes per the American Diabetes Association. With diabetes, people may not feel different or feel “sick” until the diabetes has been very uncontrolled for a long period of time. Symptoms of uncontrolled diabetes may include feeling more thirsty and more hungry, having to urinate more often, low energy or feeling tired, or blurry vision. When diabetes is very bad, you may even have weight loss. Because our bodies are really great at adapting to changing conditions, people may not feel the effects of high blood sugar even though the high levels are negatively affecting other parts of our body.

 

Diabetes. That word can mean a lot of different things to different people.

 

Sometimes people do not go to the doctor because they are worried about getting diagnosed or worried that their life will drastically change if something is discovered. Sometimes it can be hard to take time off from work to get to the appointment or you’ve had a bad experience with a health care provider in the past and are hesitant to try someone new. Maybe you feel fine and do not think a regular physical is necessary. Whatever your reason may be for not going to the doctor, I encourage you to take the first step in your health and make an appointment. Diabetes is not a life sentence. When diagnosed early and with certain lifestyle changes, many people are able to prevent progression and complications of the disease. With the right tools, you can take power over your health!

 

If you have a diagnosis of diabetes, there is a whole team of health care professionals out there to help you on your journey. A diagnosis of diabetes means you will have more regular bloodwork, need to have additional tests or vaccines, and more regular appointments. It is important to find a provider where services are provided in a safe and welcoming environment where you feel heard as a patient. It is important that if you do not understand something about your health, please speak up! Ask your doctor questions! Ask if they can explain it in a different way, repeat, or rephrase things in a different way. It does not help if you leave your appointment with unanswered questions. As a doctor, it is important to me that my patients understand so they can take an active role in making change. There are no dumb questions!

 

A very important part of managing diabetes is understanding how blood sugar (glucose) levels are measured. There are two main tests that are used: a blood glucose test and a hemoglobin A1C test. Both can be checked either through a blood draw or from a fingerstick poke. The blood glucose test measures the level of sugar in your bloodstream at the exact moment of the test. If you eat or drink prior to this test, it will affect your results. We often use fingerstick pokes with a glucometer, a machine that can measure your blood glucose at home, to identify what time of day your blood sugar is the highest and how meals affect your sugar levels. Your doctor may ask you to check your blood glucose level multiple times per day and record a food diary of what you are eating to get a sense of the patterns of your blood sugar to help inform what dietary modifications and/or medication changes would be most beneficial. The second test is a hemoglobin A1C (A1C). This test is a little different than the blood glucose test because it measures your average blood sugar level over the 3 months prior to the test. You do not need to be fasting for this test as recent food or drink do not affect the results. We use the A1C test to identify if you are meeting the goals of treatment to prevent diabetes complications or prevent progression of prediabetes to diabetes.

 

In addition to your doctor, you may have appointments with a registered dietitian. The best support will be dietary recommendations focused on your dietary preferences, your culture, and what is important to you. It is possible to continue to take part in family celebrations and traditions while making small changes or modifications to traditional recipes to improve your blood sugar. Visits with a registered nurse or certified diabetes educator may involve going through more concepts of diabetes to gain a better understanding, as well as medication education and teaching, from medicines that you take by mouth to medications like insulin that we inject into the skin. Sometimes we can control diabetes alone with medications by mouth. In other cases, we may need to use an injectable medication to help the body use insulin better. If our body is not producing enough insulin, we may need to replace it with an injectable insulin. When our bodies are low in other things like anemia, low thyroid levels, or low vitamin D, we supplement and replace with iron, thyroid, and vitamin D supplements. Many people would not think twice about taking a supplement to replace these low levels in the body. Providing you with the knowledge about your health and diabetes can help you be more familiar and comfortable with insulin and other injectable medications if these are medicines that are recommended at some point in the future.

 

For some, use of traditional herbs, home remedies, or natural supplements may be a preferred method to help reduce blood sugar. Speaking with your doctor about incorporating remedies or traditional herbs as part of your treatment plan is important to ensure that there are no interactions with any prescribed medication that you may be taking. An herb and supplement consult may be recommended with a pharmacist if some of the ingredients are lesser known. The goal is to create space to have conversations that help support patients in their self-management plan, and if that includes traditional medicinal practices, to safely blend traditional methods of healing with other recommended treatments.

 

While some people may be more familiar with some of this information than others, think about those around you: family, friends, neighbors. Being open and talking about diabetes can open up conversations with others that you might not have had before. Preventing and treating diabetes involves mental, physical, and spiritual health. Change happens on an individual level and there is also a large social and family component. A diagnosis of diabetes does not mean avoiding social gatherings and not eating your favorite foods. It means we have to be knowledgeable of how those foods affect our body and to be mindful and thoughtful about how much of each food we put in our body. Involve your family in your health so that meaningful change can be made at the family level. Your family is a resource and can help you along your health journey. Bring family members to health care appointments if that is something that you may find helpful! Formal diabetic group visits held by a health center can be a great way to meet other people who also have diabetes and to learn from one another.

 

I hope that diabetes is a little less intimidating after reading this column! With the right approach and motivation, you can feel more confident in taking steps to prevent diabetes, and if you are already diagnosed, to live a long and healthy life with diabetes. I invite readers to submit any questions or topics for future columns.

 

For more information about Tepeyac Community Health Center, please visit our website at www.tepeyachealth.org or call 303-458-5302 to make an appointment!

 

Sources: ADA Diabetes Fact Sheet. Accessed at Statistics About Diabetes | ADA

 

Pamela Valenza, MD, Chief Health Officer, Tepeyac Community Health Center.

 

 

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